On top of this patient’s questions is the fact that I am giving a lecture tomorrow to a group of dentists on the subject of dental implants in the front of the mouth. Yes, there can be differences between the front and the back of the mouth. At the lecture, I will be spending some time talking about which of the choices may be more appropriate in differing situations.
So I thought that since this subject of dental implants and bridges shows up no matter which direction I turn, I would spend some time sharing a few thoughts with you today.
To simplify things a bit, I will only be talking about permanent bridges in this column.
Defining Dental Implants and Bridges
First of all, let’s do some definitions.
Both dental implants and bridges are used to replace a missing tooth or teeth.
There is a fundamental difference between them.
When we utilize a dental implant, there is no focus on what is on either side of the implant. The only things that matter for the implant are quality and quantity of bone into which, the implant will be placed.
When we are dealing with a bridge, we need to shift our focus.
In a permanent bridge, it is all about the teeth on either side of the missing tooth or teeth. The bridge needs to anchor to those side teeth. Much like a bridge over water. The span is held up by the two or more vertical components of the bridge. In this regard, dentistry is no different.
So what influences which is the best treatment for that patient?
Factors that determine the best treatment option
The number of Missing Teeth
One factor is the number of missing teeth.
If a lot of teeth are missing then a bridge may be a challenge. Remember the span of the bridge has to stretch between 2 teeth. If the span is small, then the side teeth that support the bridge will not be overburdened. If we are replacing 3 or more teeth then we could overload those side teeth.
Before we used dental implants, we used to double connect the side teeth. That means that instead of 1 tooth holding the bridge on each side we would use 2 teeth on each side. So now our bridge is held in place by 4 teeth rather than 2 teeth.
Today, that option is still present, but adding implants to the missing tooth area might be a better choice. This way we don’t have to involve any adjacent teeth as we did in our bridge scenario.
The Condition of the Teeth
The other factor that we need to consider is the future.
If one of the teeth holding the bridge is weakened or its longevity is in question, then placing a bridge may not be prudent. Since if the anchor tooth of the permanent bridge is lost then the whole bridge is lost.
If one of the adjacent teeth has a root canal and post, the placement of the bridge could stress the post. This could lead to either fracture of the post or fracture of the root of the teeth.
When it comes to cosmetics in the front of the mouth, many times a bridge, rather than implants, may be a better choice. This is due to how the gum and bone may reshape and behave after the implant is placed. When we do a bridge, we usually don’t get involved with the gum and certainly not the bone. This means that the guess of how the gum will look as it relates to the tooth will not be needed. The final position and shape of the gum will not vary and we can plan accordingly.
We Customize a Solution For You
I could go on and on discussing varying differences. However, my space is limited. These are some of the thoughts that go through my head when I am asked to come up with a solution.
This solution will have a tremendous effect on your present oral health and on the future of your teeth. As we all know, this can greatly impact your quality of life as the years go on.
If you want to learn more or have a specific question, please call Megan and schedule a consultation. There is no charge for this meeting as I enjoy talking about it and educating you. In fact, it is my passion! I can be reached at 440.951.7856 and look forward to hearing from you.
Typically, If you describe someone as being ‘long in the tooth’, you are saying derisively or humorously that they are old or aging.
However, there may be more at stake than hurt feelings.
Clinically speaking, having an unusually long tooth or teeth can be symptomatic of a much bigger problem. Gum disease.
My Tooth Became Really Big. Can You Help Me?
I saw this new patient last week, and she was correct. When you looked at her, all that you saw was one tooth. I don’t mean that one tooth was all that was present. She has many teeth that show when she smiles and talks. What I am referring to is one tooth that stands out more prominently than all of those around it. She was literally ‘long in the tooth’.
How did it stand out? First of all, it was much longer than the teeth on either side. It was her cuspid, or “eye tooth” as people commonly refer to it. The tooth is a large tooth, to begin with, but this was even larger and more prominent than we usually see.
The tooth was also pushed forward. When a front tooth is pushed forward, two things can result. First of all, the tooth may bite on the lower lip and therefore feel strange. It also causes a protrusion of the upper lip.
To top off these calls to attention by the tooth, the color of this tooth was whiter than the rest.
Gum Disease Spreading to the Bone
I recently wrote about shorter teeth. Shorter teeth come as the result of years and decades of wear of the biting surface as we get older. I also mentioned some teeth could do just the opposite. They appear to get longer as the gum and bone shrink a little away from the tooth.
My new patient was not an example of either scenario. Her tooth got much “longer” because of gum disease.
Gum disease starts in the gums and then spreads to the bone. This condition is a bacterial infection that will destroy the bone in which the tooth rests. If the disease damages all of the bone, then the tooth will become loose. If you are lucky enough, you won’t experience any pain, and one day, the tooth will fall out of your head. More likely than not, you will have swelling and discomfort requiring help from a professional to either save the tooth or remove it, depending on the severity of the situation.
A Good Analogy
Once the bone is attacked and slowly is destroyed, the tooth loses its primary stability. Let me give you an analogy. Think of a post implanted in the ground. If the earth is covering a good portion of the post, then the post remains stable. If the ground erodes away from the post and more post is above the surface than in the earth, instability will appear. The post will become movable, and if pressure is applied, it will no longer stand perfectly straight. It will start to lean to one side or the other.
The same thing happens to a tooth with gum disease, and this is what I saw in the mouth in question. Fortunately for her, the bone destruction did not extend significantly to the adjacent teeth. I recommended removing the tooth and replacing it.
As for the fact that this tooth was also whiter than the rest is because she had an old crown on the tooth. That crown matched her teeth years ago and was thus whiter. No matter how I replace the tooth, I would correct the color and make it match its neighbors.
So how did I plan on replacing the tooth after removal? Our choices were either a single implant or a permanent bridge which can’t come out.
After an evaluation, I recommended a bridge for two main reasons.
1. The first reason centers on the fact that the bone loss was resulting in the bone moving upwards. If I placed an implant, the resultant tooth would be very long.
Remember that was one of her initial concerns. A permanent bridge would deal with this long tooth issue better.
2. Secondly, I would utilize my “Same Day-Immediate Bridge” technique that I developed. It allows me to remove a tooth and provide a replacement in usually less than an hour. We did that, and she left with a stunning and much-improved smile.
Taking Advantage of Our “Better Than Insurance” Program
Best of all, she took advantage of our “Better than Insurance” program that I mentioned in the last couple of columns. Rules do apply, but she met all of the criteria and saved 20% of the fee. She looked terrific, and we saved her money! Another happy customer and a healthy smile!
Call Megan today at 440.951.7856 and find out about our “Better Than Insurance” initiative to save you money and preserve your smile for a lifetime.